What can make you feel like you are having a heart attack?
What can make your asthma worse?
What can make you hoarse and give you a sore throat?
What can increase your risk of a serious cancer?
The medical diagnosis that is related to all of these is called GERD, or gastroesophageal reflux disease. GERD is more commonly known as heartburn, though it is not related to the heart.
This very common condition occurs when the acidic content of the stomach, instead of emptying into the small intestine, refluxes backward into the esophagus, the swallowing tube between our mouth and stomach. The corrosive effect of this acidic material can make us belch, give us a bad, brackish taste in the mouth, and irritate our vocal cords. Even worse, it may be the precursor to chronic esophageal inflammation as well as conditions like eosinophilic esophagitis, scarring and strictures, or the pre-malignant Barrett’s esophagus.
Contributing to this condition is overeating, obesity, hiatal hernia, lying down after a meal. Certain foods increase reflux including caffeine, alcohol, chocolate, spicy or fatty food, onions, and peppers. Peppermint is offered at many restaurants as a take out candy not just to improve your breath, but to relax the lower esophageal sphincter, which allows us to burp and discharge air from the stomach. This make us more comfortable — but can worsen reflux as well.
Standard recommendations are not to lie down for at least two hours after eating, avoid offending foods and beverages, or sometimes elevate the head of the bed by about 6 inches or use a wedge pillow. Weight loss, tobacco cessation, and avoiding tight fitting garments can help reduce GERD. Sometimes a large hiatal hernia is present and must be surgically repaired. Infection with Helicobacter pylori should be ruled out and treated if present.
Antacids are the mainstay of treatment. Most commonly these are the “purple pill” type of proton pump inhibitors like omeprazole and pantoprazole. While often effective, these medications have a number of side effects. These can include decreasing absorption of essential nutrients, increased risk of bone fractures, heart attacks, and pneumonia, as well as bacterial overgrowth in the gut. Discuss the risks and benefits of these medications with your doctor. If you are already on these medications, you might consider a tapering protocol. Transitioning to H2 blocking antacids like ranitidine or famotidine may be similarly effective with less risk.
Though typically a clinical diagnosis, a common procedure to assess GERD is the upper gastrointestinal endoscopy or EGD. This helpful and safe outpatient procedure can detect esophagitis, strictures, hernias, and cancerous or precancerous changes.
Alternatives to prescription antacids are aloe vera, deglycyrrhizinated licorice (DGL), rice bran oil and slippery elm. Chewing sugarless gum can be helpful to keep things moving down rather than up. Drinking more water, eating bananas and using stress management and relaxation techniques can all be helpful as well. Mindful eating helps you digest food more effectively and can reduce GERD.
In summary, do not ignore symptoms of heartburn and reflux as it can be a mimic of or precursor to more serious conditions.
Speaking of heartburn, here’s a quote from Lao Tsu that might be useful in the context of current events:
I have three treasures, which I hold and keep.
The first is mercy; the second is economy;
The third is daring not to be ahead of others.
From mercy comes courage; from economy comes generosity;
From humility comes leadership.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.